HEDIS Nurses (RN/LVN/LPN) *Remote*

DRCC is calling HEDIS Nurses (RN/LVN/LPN) who will:
? This position maintains a working knowledge of the organization?s current medical management systems, business processes, and workflows to support HEDIS and Quality-related activities. The HEDIS Nurse supports the HEDIS team.

This position is fully remote.

Job duties:
? Interpret, clarify, and implement changes accurately through the maintenance of current knowledge of HEDIS technical specifications.
? Demonstrate the ability to accurately apply technical specifications when performing chart reviews and communicate changes and clarifications to impacted business units within the organization, as appropriate to perform the primary function of medical record validation and support education/ outreach based on required NCQA standards.
? Support outreach and education projects related to HEDIS, Supplemental Data, and other quality improvement initiatives. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
? Act as a liaison between the Quality Improvement/HEDIS department and other departments, practitioners, and providers in support of HEDIS-related programs and activities.
? Review medical record submissions for supplemental data, in support of company?s audit standards and requirements for HEDIS reporting.
? Review all medical record abstractions with a high attention to detail to ensure the company is compliant with the high-quality standards set for HEDIS medical record audits 97% accuracy rate.
? Participate in medical record abstraction and accuracy validations (overreads) for various HEDIS efforts, such as the annual hybrid pursuit, prospective chart reviews, and other quality improvement project reviews.

Preferred qualifications for this position include:
? HS Diploma or GED Equivalency
? Licensure / Certification: Registered Nurse/Licensed Practical Nurse, Certified Healthcare Record Reviewer (CHRR?) or Certified Risk Adjustment Coder (CRC?).
? Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes.
? Computer applications, including word processing, database, and spreadsheets. Proficient in Microsoft Office Suite. Excellent interpersonal/communication skills.
? Strong attention to detail. Ability to handle multiple projects and strong problem-solving capability.

Company DescriptionWorking from home within our company provides the flexibility needed for improved schedule management, promoting a healthier work-life balance and lowering stress levels. It removes the need for commuting, which saves both time and money, while also being environmentally friendly. This arrangement enables the creation of a customized and productive work environment, enhancing focus and the overall effectiveness of quality measures and revenue cycle.

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